Laparoscopic approach to gastric remnant-stump: our initial successful experience on 3 cases.
BACKGROUND
Laparoscopic treatment of gastric adenocarcinoma is still a debated issue. In this paper, we retrospectively reviewed 3 cases of laparoscopic treatment of gastric remnant-stump adenocarcinoma. We analyzed the feasibility, the postoperative outcome, and the short-term results.


METHODS
From January 2003 to September 2005, we carried out 3 laparoscopic completion gastrectomies for cancer of the remnant stomach. All patients were males, between 59 and 73 years old. All of them had a previous history of benign gastric ulcer that required a Billroth II subtotal gastrectomy. We always performed a D2 lymphadenectomy and a Roux an Y side-to-side esophagojejunostomy.


RESULTS
No conversion was necessary. Mean operative time was 210 minutes (range: 160 to 260 min). No intraoperative transfusions were applied. We had 1 postoperative bleeding managed conservatively with 2 units of blood transfusion. In 1 case, the esophageal transit study showed a tiny anastomotic leak, not clinically evident, which was managed conservatively. The mean peristalsis was present at 56 hours (range: 48 to 72 h). The mean postoperative stay was 11 days (range: 8 to 18 d). In all cases, histologic examination was positive for adenocarcinoma. The mean number of lymph nodes was 18 (range: 12 to 26). The TNM status was: T2N0M0, T3N0M0, and T3N1M0. Resection margins were negative in all cases (R0). The mean follow-up was 17.6 months (range: 11 to 24 mo). The patient with positive lymph node died 11 months after the operation for metastatic disease.


CONCLUSIONS
In our preliminary experience, laparoscopic treatment of gastric remnant-stump adenocarcinoma has been demonstrated to be technically feasible and sure. The histologic examination confirmed a proper surgical dissection. Also, if it is an initial experience, we believe that laparoscopy could be considered a valid opportunity to open surgery.
Corcione
Francesco
F
Department of General and Laparoscopic Surgery, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
Pirozzi
Felice
F
Marzano
Ettore
E
Cuccurullo
Diego
D
Settembre
Anna
A
Miranda
Lucia
L
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005743:Gastrectomy / Q000379:methods*; D018530:Gastric Stump / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*